Speech by Kieran McCarthy in support of Amendment to HPSS Bill

“May I begin Mr Speaker (/Madame Deputy Speaker) by declaring an interest in this series of amendments, as I am Chair of the Assembly Cross Party Group on Ageing and Older People.”

“The amendments in my name will have the effect of extending the provision of the Bill to include free Personal care AS WELL AS free Nursing care. Whilst I welcome the introduction of free nursing care, I believe that in the absence of free personal care the Bill is seriously flawed and will not resolve the issues at stake.”

“My proposed amendments seek to rectify this unsatisfactory situation. These amendments are for the benefit of a great many of our elderly people.”

“I ask Members to support my amendments for the following reasons.”


These amendments enable US to right a wrong. Age discrimination is real. These amendments are to assist in its elimination in Northern Ireland. They will ensure that one of the most vulnerable groups in our society no longer suffers discrimination. Which of us in this chamber today has not spent his or her political life condemning discrimination, ALL forms of discrimination. If these amendments ARE NOT PASSED, we will in effect be permitting the injustice of age discrimination to continue.”


Because other devolved administrations ARE addressing this issue of personal care. Scotland will be implementing free personal care from 1st July, and the Welsh Assembly has expressed an aspiration to do [something similar?].”


Because on 27th February last year, this Assembly passed the following motion:

‘That this Assembly notes the decision of the Scottish Parliament to provide the elderly with free nursing care AND free personal care and calls on the Executive Committee to make similar provision for the elderly in Northern Ireland.'”

“This Assembly passed this motion unanimously.”

“Now is anyone who voted for free personal care last February going to have the conscience to vote against it today? What justification could there be for such an action? Members could hardly plead ignorance of the consequences. People would not be fooled. They would see clearly the shameful political opportunism in supporting a motion, thinking it would get no further, and opposing the actual proposed legislation now upon this Floor. NOW is the time for us to put our money where our mouths are.”

“In fact, the present Bill, which EXCLUDES free personal care, is the result of the Executive’s selective response to the motion passed by this Assembly last year. And I have to say that this is not the first time the Executive has shamefully ignored the will of this Assembly.”

“As Members will know, the origin of the present debate on residential care is the report of the Royal Commission, presented to the Westminster Parliament in March 1999 – and isn’t it disgraceful indeed that these proposals are only being partially addressed now, more than 3 years later? It was called ‘With Respect to Old Age’, and the dual meaning is clearly deliberate – indeed, an acknowledgement that the care system did not RESPECT the people who had become too ill to retain their independence.”

“The Royal Commission Report was considered by many to be the most accessible and well researched reports of its kind. The single volume report is supported by THREE volumes of research.”

“What was one of its key recommendations? The Royal Commission said:

‘In our judgement it is right for the state to exempt personal care from means testing altogether.'”

“What is the rational for this?”

“It is based on the grounds of both equity and efficiency.”

“However, it is important to note that neither the Royal Commission nor these amendments envisage the state paying for living and housing costs. These costs would still be met by people whose assets were above the threshold.”

“Yet older people incur personal care costs when they can no longer be looked after at home or cannot be sent home after hospital treatment. The need for personal care is unpredictable and no fault of those who require it. The Royal Commission argued that personal care costs should be met by the State. They reflect what the Royal Commission called ‘the true risk and catastrophic nature of needing Long Term Care’.”

“Paragraphs 6.33 and 6.34 of the Royal Commission’s report state:

‘The justification for our view if based on considerations of both equity and efficiency. Whereas the state through the NHS pays for all the care needs of sufferers from, for example, cancer and heart disease, people who suffer from Alzheimer’s disease may get little or no help with the cost of comparable care needs. All these conditions are debilitating, but Alzheimer’s disease cannot yet be cured by medical intervention. However, a mixture of all types of care, including personal care will be needed. This is analogous to the kind of care provided for cancer sufferers. The latter get their care free. The former have to pay.”

“‘For this reason the distinction between the way care is offered for different diseases has no justification. The situation must be put right. The proposal to exempt personal care from means testing would do that.'”

“One consultee is quoted as saying:

‘So many of my contemporaries have had so much NHS money spent on them over the years. Aneurisms, heart operations, orthopaedic ? they have not been charged at all. Does it seem fair that the mentally ill have to be charged when someone physically ill can have it free whatever their income?'”

“And Professor Robert Stout of Queens University, himself a member of the Royal Commission, reminded the Health Committee in a written submission that:

‘Introducing free nursing are alone would introduce a new perverse incentive. It would mean that nursing homes would be subsidised whereas residential homes, which do not have registered nurses on their staff would have to charge full costs. There would be an incentive, both for the individual and for the Trust, to admit patients to nursing homes even if they do not require that level of care. This is contrary to best practice in providing long term care, which is to provide only the level of care needed by the individual.'”

“The Royal Commission also believe that making personal care free would enhance the dignity and security of old people, and go a long way to making services provided for long term care as valued and as jealously guarded as those provided by the NHS. The principle of equal care for equal needs would be properly recognised, for the first time.”

“Surely, if we really meant what we said when we signed up to the concept of equality enshrined in Section 75 of the NI Act, we can do no less than support these amendments.”

“Remember too that today’s older generation were the ones who entered into a contract with the government and built the NHS in partnership with successive administrations. They met their responsibilities over the years, paid their tax and national insurance contributions and in return were assured that when they needed it, the NHS would be there, and that they would be looked after, from the cradle to the grave. Yet they have found out that when they are at their most vulnerable and needy – it is not there. Small wonder that older peoples organisations and advice lines generally have encountered such anger and bitterness over this issue.”

“These amendments detail what personal care is – and I suspect many members may NOT have realised what was excluded from nursing care. I think these amendments highlight the fact that drawing a line between the two is artificial and unworkable. It will cause further confusion, anxiety and bitterness.”

“We need to look no further than England to see the reality that has ensued there.In March 2002, Paul Burstow MP, the Liberal Democrat Shadow Minister for Older People, published evidence depicting the Government’s free nursing care as a shambles.”

“He revealed that 3 out of 5 Health authorities in England had evidence that nursing homes were failing to pass on payments in the form of reductions in fees for residents, that 1 in 5 people eligible for “free” nursing care are still waiting for a reduction in their fees and that 5,636 people were banded without having been seen by a nurse. Furthermore, problems in administering the scheme meant that payments of up to £11.9 million were outstanding.”

“Would members really want us to get into this situation here?

At present, the method of assessing those in need of care is under review. The Department has issued a report out for public consultation. I am perfectly sure that the members of the working group have worked hard to produce the assessment tool, but how satisfactory is it? Assessors have indicated that an assessment would take 1 to 1½ hours. There are 21 domains to be assessed. Perhaps I can give you an example of what some of these entail:

Category 2: ‘Ability to adjust emotionally and awareness of moods and stimuli that elicit emotions. Capability of expressing desire for emotional support’

Category 3: ‘Knowledge of abilities and constraints and ability to act accordingly in fulfilling personal goals’

Category 21: ‘Care needs of relatives and carers arising from their relationship with the older person or their role as carer. Needs that are important to the maintenance of an established relationship or the transition to a new role'”

“Allowing an hour and a half for an assessment allows less than 4 minutes on average for each of the 21 domains; 2 hours gives an average of 5 minutes for each. This does not allow for time to make three final overall assessments or to check on the completed 12-page document. Surely this can only be a snapshot – would you be happy if an elderly relative has his or her needs assessed in the same way?”

“How many would argue that its use is preferable to the introduction of free personal care that would render it obsolete?”

“The Health Committee has also been influenced by cost. The Executive has established an interdepartmental group to examine cost and the Health Committees report states that ‘estimates of providing free personal care are likely to be well in excess of £25 million per annum’, which was an approximate estimate by the Right to Care Campaign of the cost of its introduction. However, I note:

·That no actual figures or explanation for this statement is given

·That there is no evidence that any member of this Interdepartmental Group gave evidence to the Health Committee

·That the Interdepartmental Group has not taken evidence from any other groups, particularly from organisations such as Age Concern or Help the Aged and others working with elderly people

·That although a report from this [Health?] Committee was due this month, it has not appeared in time for debate on this Bill – rather strange and irregular.”

“Older people and their organisations have a long list of services they want to see improved, a number of which they argue ACTIVELY discriminate against older people. They accept that delivering these improved services will take time.”

“However, they have made this issue of personal care a priority. In tabling these amendments, I am acting in the knowledge that I am doing so on behalf of those older members of our community. I believe passionately in the justice of this proposal and it has been an honour for me to speak on their behalf.”

“I commend these amendments to the House, and ask Members to support them.”

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